Archive for November, 2006

Methods: A PubMed search was done using the words “measles immunization campaigns.” 169 Articles were found. Of those, 15 were thought to be applicable.

A: Measles vaccination campaigns can reduce measles cases by as much as 90%, and eradication of the disease is a possibility with effective, comprehensive campaigns.

A September, 2005 Lancet article reported on 19 African countries that had completed measles immunization activities in children aged 9 months to 14 months between 2000 and June, 2003. 82·1 million children were targeted for vaccination in 12 countries and follow-up immunization in seven countries, reaching an average of 97% of the targeted population. The average decline in the number of reported measles cases was 91%. They also estimated the percentage decline in annual measles deaths to be around 20% (90 043 of 454 000).

There were several limitations to this study. First, measles cases were defined based on a clinical criteria (an illness characterised by rash, fever, and cough, coryza, or conjunctivitis), or “any illness that a clinician suspected to be measles.” Diagnosis (and, therefore, reporting) of measles cases, then, depended on the clinicians’ training, as well as possible discrepancies in the very definition of measles. Number of deaths averted were also estimated based on the percentage of measles deaths from prior years.

A report by the CDC estimated that cases of measles fell from 8,762 to 2,574 (about 70%) in 2002 after a mass immunization campaign in Afghanistan. An estimated 82% of the targeted 6 months-12 years population was reached.

I have met relatively few members of the LDS faith, however, who are dedicated to solving global health disparities in a sustained, systematic fashion. Why? Here are a few possibilities:

1. There ARE many Mormons involved in global health. I just have not met them yet. This very well may be the case; hopefully through this blog I can meet you!

2. The large families, chruch responsibilities, and other activities make a long-term committment to global health very difficult. Probably the case. Global health can be a very time and resource intensive undertaking.

3. The emphasis among Mormons is more on performing humanitarian service than it is on results. (More on this on a future blog!)

It seems to me that the truth is some combination of the three.

(Please note that I am not asking why the LDS Church is not more involved in global health. I recognize that the mission of the Church is not specifically to decrease health disparities, though it has done much to do so. For more on the mission of the LDS Church, see here. I am asking why more members themselves are not doing more independent of the Church. Please also note that I am not at all interested in criticizing or judging specific people, or groups of people. I’m sincerely wondering why there aren’t more LDS people involved in global health; it seems like there would be.)

Right now, this blog consists entirely of my ramblings. That would be fine, I guess, if I had all of the answers to the unacceptable global health disparities. Unfortunately, I don’t. So, I’m looking for co-bloggers and guest bloggers and other helpers. I think that about 8-10 people total would be ideal.

So, if you agree (or if you know someone that does) that something more must be done about the current global health situation, and if you think that a blog is a good way to share ideas, announce events, etc., email me at unacceptableglobalhealth@gmail.com.

Ideally, my co-bloggers would need at least as much experience OR motivation as I have (not too tough). For now, my blog is directed to the LDS (MORMON) and Utah Valley, Utah communities because they are my communities.

RESULTS is a “nonprofit grassroots advocacy organization committed to creating the political will to end hunger and the worst aspects of poverty.” There seems to be an emphasis on microcredit and health, withmore than 800 volunteers in 100 communities in the US.

There are RESULTS groups in Provo and Salt Lake City, Utah; I went to my first meeting in Provo on Saturday. Here are a few of the highlights:

–Worlds AIDS day is December 1, and we will be submitting a several letters to the editor addressing the need for more tuberculosis funding.

Meetings, consisting mostly of conference calls and committments to action, are held monthly. The next meeting and conference call will be on Saturday, December 9 at 12 noon at 2198 JFSB (new building west of the library at BYU). We hope you’ll join us if you live in Utah Valley!

I have been a practicing physician for over 3 years in the United States and I have never seen a case of measles. My wife’s grandfather remembers “red measles” (as opposed to “German measles,” or rubella) going through “the whole family and the whole town.” Measles was a part of life; 90% of children had measles before they were 15 until a vaccine was licensed in the US in 1963.

Measles is now a disease of the poor. Virtually unheard of in countries like the US (fewer than a few hundred cases a year), it continues to kill thousands of children in developing countries despite the fact that it is easily preventable. Estimates in 2004 put 454,000 children dying of measles in 2004. That number has been steadily declining since 1999, likely due to mass immunization campaigns.

Measles is caused by a virus, and transmitted by respiratory secretions. Approximately 2 weeks after contracting the virus, the child gradually develops a fever, followed by the “3 C’s”: cough, coryza (runny nose), and conjunctivitis (red eyes). A characteristic rash then develops. Most recover without further problems. Complications that can lead to death include dehydration due to diarrhea, pneumonia (infection of the lungs), and encephalitis. (Manson’s Tropical Diseases) The mortality rate (percentage of those who get the disease and die from it) ranges from 0.1% to 25%, due to malnutrition and vitamin deficiencies.

I have been asked that question multiple times, and I have asked myself that question many times. Once one comes the the conclusion that the current global health situation must be changed, the next step can be quite daunting. Since I do not know your level of commitment, amount of free time, political or moral philosophy, or previous experience, I cannot give specific recommendations. There are, however, a few couple pieces of advice that apply to everyone (myself included), and I am convinced will make a difference:

1. Consider your motivations. Why do you want to get involved in global health? Be honest with yourself. While everyone probably has several motives, any motivation other than improve health has the potential to distract from that end. Is it to fulfill a personal need to perform humanitarian service? A desire for adventure or foreign travel? Further political aspirations? Professional advancement through research or publications?

2. Approach global health the way you would any other professional or business endeavor: have a serious, long-term, committed, sustained, professional approach. Take time to research in depth the problem. Consider various solutions. Meet and communicate with people that share your approach. Be flexible. Be patient with organizations, governments, and people; change takes time. Reconsider your assumptions about health and poverty. Plan ahead. Monitor progress with meaningful markers, and make changes if things aren’t going as planned. Insist on sound data-collecting processes, and make decisions based on that data. Make and keep deadlines. Meet obstacles as bumps in the road, as opposed to project-ending road blocks.

This is the first of a number of articles exploring Mormonism and Global Health.
In 2003, the LDS Chruch donated 3 million dollars to the Red Cross to support the Measles Initiative . According to the initiative’s website, it “is a long-term commitment and partnership among leaders in public health and supports the goal of reducing measles deaths globally by 90% by 2010 compared to 2000 estimates. Measles Initiative partners include the American Red Cross, UN Foundation, CDC, World Health Organization, and UNICEF.” Evidently the Church is the primary supporter of the initiative. The Church has also called missionaries to serve in Madagascar, Ivory Coast, Kenya, Mozambique, Nigeria, Benin and Tanzania, where they serve social mobilization roles. In the coming days, I will post a Global Health Topics article on measles, followed by a Q&A post answering the question “how effective are measles vaccination campaigns”? I will also have an invited blogger couple who will share their experiences as Mormon missionaries working with the Measles Initiative.